Dentistry for the aging population
“ Patient age alone is never a limiting factor .”
Frauke Müller | Switzerland Professor and chair of gerodontology and removable prosthodontics University Clinic of Dental Medicine , Geneva
We age healthier and live longer than we did a few decades ago . What does this mean for the oral health of elderly patients ?
Gerodontology facts
A geriatric patient shows physiological signs of aging , e . g ., decline in mobility and function , tactile perception , vision and manual dexterity . These signs are generally progressive and irreversible up to the point that the patient may become dependent on help for their daily activities . When we provide a denture for such a patient , special considerations are necessary . Also , the legal contexts , e . g ., patient consent and compliance , are different compared with younger patients .
Gerodontology is a specialty combining all disciplines of dentistry . It also overlaps with other disciplines , e . g ., nutrition and public health . We still do not have many independent gerodontology departments worldwide , but the specialty is becoming more recognized , and university structures are adapting .
Now we have studies with 85 + as the patients ’ average age . We lose teeth much later in life , due to our healthier lifestyles , and there have been developments in dental materials , implants and regenerative dentistry . If all goes well , we can keep all our teeth right to the end . But due to much longer life expectancy , we may still experience some tooth loss . And edentulous patients are quite different from the ones we had 50 years ago . They are much older ! Their mucosa is more fragile and inelastic . Their spongiosa becomes more brittle and affects the alveolar crest . The bony structure of joint articular tubercle is also subject to atrophy , so there are a lot of changes in the temporomandibular joints . We also have loosening of the ligament structures and atrophy of muscle bulk . Patients may lose about 40 % of their musculature over their lifetimes , which leads to less precise and less coordinated motor skills . We also see changes in the central nervous system and neuroplasticity , whereby the brain cannot easily adapt to the movement patterns of a new dental arch . All these factors should be considered when we define the occlusion for an elderly persons ' prosthesis .
Do teeth age faster than the rest of the body ?
The oral cavity is part of the general human organism and may age the same way . Sometimes chronic oral diseases are the first indicators of something happening to the body . For example , with the onset of neurodegenerative disease , we lose weight in a very short time . The first sign is usually when dentures loosen . Patients come to see us , even if denture relining was done just six months previously . Analyses show the patient has weight loss and should be sent for more in-depth evaluations .
Osseointegration happens in older age too .
Elderly patients should benefit from what modern dentistry offers , just like younger patients . Implants are very helpful for elderly patients , e . g ., for retention of dentures . We also know that osseointegration happens in older age . In fact , the survival rates for implants are very good – over a 10-year observation period , 9 out of 10 implants will still be in place .¹ Age
Our life expectancy has changed over the decades .
Some 50 years ago , geriatric dentistry was barely developed , and there was a reason for that . The average age of the edentulous patient cohort was often 50 – 60 , which is no longer the case .
“ Elderly patients should benefit from what implant and regenerative dentistry offers , just like younger patients .”
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